Winter 2004

Fraud Corner
By Terre Tomblin
Manager of Special Investigations

GUILTY—Jaime Cano of Brownsville pleaded guilty to workers’ compensation fraud-related charges. A Travis County judge sentenced Cano to six months of deferred adjudication and ordered him to pay a $200 fine and $3,916 in restitution to Texas Mutual Insurance Company.

Cano allegedly suffered a work-related injury. His doctor placed him in off-work status, and Texas Mutual Insurance Company began paying Cano temporary income benefits (TIBs).

Meanwhile, Cano’s employer became suspicious that he had begun working for another company while continuing to collect TIBs. State law allows injured workers to receive TIBs only while they are unable to work. The law also requires injured workers to notify the workers’ compensation insurance company when they begin working again.

Texas Mutual^® staff repeatedly asked Cano if he was working while collecting TIBs, and he repeatedly denied it. Texas Mutual Insurance Company opened an investigation, which got a big break when Cano’s new employer confirmed that he was working.

Investigators call this sort of scam “double-dipping” because the claimant gets paid by his new employer for working and, in effect, gets paid by his previous employer’s insurance company for being too hurt to work. Double-dipping scams, if allowed to continue, can lead to a higher workers’ comp insurance premium for the first employer when the company renews its coverage.

GUILTY—Quenton Durrett of Durrett Demolition in Manvel, Texas received a one-year sentence, suspended for four years, for workers’ compensation fraud-related charges. The 167th District Court of Travis County reduced the charges to a misdemeanor, and ordered Durrett to pay a $500 fine and $26,000 in restitution to Texas Mutual Insurance Company.

According to Texas Mutual^® investigators, Durrett repeatedly claimed that his company had no employees and no payroll records. An investigation uncovered evidence showing that Durrett maintained a company bank account from which employees were paid, and he used two payroll companies to pay the Durrett Demolition payroll.

Workers’ compensation insurance premiums are based, in part, on payroll. The fraud allowed Durrett to avoid paying the correct premium for his company, and it left Texas Mutual Insurance Company liable for injuries sustained by his employees.

GUILTY—A Travis County district court accepted an Odessa man’s plea bargain to reduce his workers’ compensation fraud case from a State Jail Felony to a Class A Misdemeanor.

William Scott Anderson claimed his alleged accident had left him unable to work. When a second company called to check Anderson’s references, his former employer alerted Texas Mutual Insurance Company.

The ensuing investigation uncovered evidence showing that Anderson had taken a new job, despite telling his adjuster that he was unable to work.

Anderson received deferred adjudication probation for 180 days’ confinement, and he must pay court costs and make restitution of $1,530 to Texas Mutual Insurance Company.

Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud. Click here to view our latest fraud-fighting successes.

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